It goes without saying that hiring drug impaired nurses or nurses who engage in drug diversion is a huge liability for healthcare organizations. It has become an unfortunate trend within the healthcare field for nurses, as well as other medical staff, to engage in unethical activities involving prescription drugs. Due to the rise in cases and potential risk to patient care, healthcare organizations are implementing enhanced measures to identify nurses who may be or have engaged in unethical activities involving prescription drugs.
There are currently over two and half million active nurses in the United States. At any given time more than 50,000 of those active nurses are sanctioned by a licensing authority or excluded from federal healthcare programs (i.e., Medicare, Medicaid). An estimated 10-15 percent of nurses, or 1 in 10 nurses, “may be impaired or in recovery from alcohol or drug addiction,” according to the American Nurses Association (ANA). Nurses are not at a higher risk to develop drug or alcohol dependency compared to the general public; however, their pattern on dependency is unique because of their access to drugs.
Nurses may turn to drug use to ease situational stress from home and work. On a daily basis nurses must handle the emotional demand of patients and their families during long work shifts that may be physically taxing and involve making life or death decisions. With the feasibility to acquire drugs at work some nurses may turn to drug use to alleviate their stress. Particularly nurses that work in high tension/high stress work environments experience higher levels of substance abuse. In many cases of drug abuse, these nurses are under the belief that because he/she knows how to medicate patients then he/she is also qualified to make medication decisions for him or herself. Aiding the situation is the ability to easily obtain controlled substances by (1) getting a physician to write the prescription; (2) stealing script pads to forge prescriptions; (3) diverting drugs by administering partial doses to patients and saving the rest; (4) having a co-worker cosign a narcotics wasting record without witnessing the disposal; (5) obtaining drugs for discharged patients; or (6) using drugs refused or not consumed by patients.
Substance abuse if usually first discovered by the abuser’s co-workers. However, it commonly goes unreported by co-workers because of reluctance, fear of retribution and damage to the company’s reputation. Compounding that reluctance and fear is their concern for their co-worker’s livelihood, loss of job and license and reputation.
Drug diversion and addiction are major problems among nurses and other healthcare professionals. A reminder of this problem was highlighted in a recent Boston Globe article about individuals fraudulently obtaining nurses’ licenses. Massachusetts discovered individuals submitting applications for nurse licenses using fraudulent information. Thirteen Massachusetts nurses were found to be providing nursing services without a proper license. The investigation found these individuals lied about having nursing degrees and/or being licensed in other states, health department documents show. Some individuals had falsely stated they had passed a national nursing licensure exam, completed a nursing education program, and met the nursing practice requirement. This raised questions about the background checks made by state regulators and providers. Some of the individuals submitted paperwork in one state, claiming they already had a nursing license in another states, in order to obtain a license. Most state nursing boards will reciprocate the license if the individual is licensed in another state; the board will waive testing requirements, as well. Massachusetts investigators were looking into licenses that were issued under reciprocity from another jurisdiction.
Healthcare organizations face serious consequences for employing improperly qualified nurses or employing those nurses who have lost their license. An impaired or unqualified nurse means patients were treated by unqualified persons affecting patient safety and creating quality of care issues. This in turn raises potential liability, including tort action suits for negligent hiring or patient neglect; enforcement penalties by the OIG; and risking conditions of participation and financial penalties.
Different course of actions can be taken, depending on the nature of the problem, when a nurse is impaired by drugs or alcohol or is involved in drug diversion. Carrie Kusserow, MA, CHC, CHPC, CCEP, a health care consultant of 15 years and Senior Vice President at Compliance Resource Center, LLC, advises how to address these types of situations. First, if determined that a nurse has worked while impaired by drugs or alcohol they should be immediately confronted with the facts. When confronted, nurses will likely cooperate and admit they have a problem, particularly when they are offered treatment and rehabilitation through an employee assistance program. Second, a nurse must be terminated immediately if they are excluded and confirmed on the U.S. Department of Health and Human Services Office of Inspector General’s (OIG) List of Excluded Individuals and Entities. The organization must then decide whether the time worked by the excluded nurse is significant enough to self-disclose to the OIG. Finally, if a nurse is found to have engaged in diversion of patient drugs or fraudulently obtaining drugs, it is not only a matter of termination, it also requires notification of the state licensing board and to drug enforcement agencies.
Because of the potential risk to patient care and safety, compliance officers of healthcare organizations are implementing new measures and enhanced ones already in place. The goal of these measures is to reduce the potential of employing nurses impaired by drugs or alcohol or are involved in drug diversion. Compliance officers should ensure the following.
- Proper sanction screening of nurses against the OIG’s List of Excluded Individuals and Entities (LEIE), their state Medicaid exclusion database and the state Medicaid exclusion database from the nurses former state(s) of residence (if applicable) during the hiring process and then on a monthly basis during employment.
- Complete credential verification during the hiring process and check the nurse’s former state(s) of residence (if applicable).
- Implement policies and procedures that mandate reporting by anyone who knows of or witnesses an impaired nurse or one that is diverting drugs. The policy should include non-retaliation/non-retribution for those who report in good faith.
- Conduct prompt investigations of all reports and information that suggest drug abuse or drug diversion.
- Implement a policy and procedures on reporting anyone involved drug diversion to appropriate enforcement agencies and licensing authorities.
- Maintain an effective and well publicized employee assistance program.
- Follow solid internal controls about wasting drugs used in the healthcare organization.
- Maintain an anonymous and confidential hotline to receive reports on workplace drug and alcohol abuse and drug diversion.
- Train employees, medical staff, contractors and anyone engaged by the organization on how to report workplace problems.
- Conduct exit interviews with nurses to gain knowledge of any drug use, abuse or diversion in workplace.
Drug use and drug diversion among nurses will always be present. However, a healthcare organization can take the right steps to remediate their risks and protect their patients and staff.
 “The impaired nurse: Would you know what to do if you suspected substance abuse?” American Nurses Today. (August 2011) Vol. 6 No. 8. << http://www.americannursetoday.com/the-impaired-nurse-would-you-know-what-to-do-if-you-suspected-substance-abuse/ >>